CHEST TUBE REMOVAL: COMPARISON OF TWO PAIN MANAGEMENT IN PEDIATRIC CARDIAC SURGERY

Background and aim: Cardiac surgery requires the insertion of drainage into the pleural or mediastinal spaces. These drains are generally removed within 24 to 48 hours after surgery. Removal of the cardiac/thoracic drainage/tube (Chest Tube Removal: CTR) is associated with moderate to severe pain. During CTR, separating the thoracic tube from tissue causes pain in patients because,while the drainage isin place, the endothelium covering the thoracic cavity adheres to the tube. The tensile force of the tube removal can tear these adhesions and cause pain. Literature highlights how early removal can reduce the perception of the painful stimulus of this procedure. However, this is not always possible; indeed, in some cases a tube remains inside of a patient for several days and its removal may take place outside of intensive care, in the “general” ward. Pain from CTR can cause inadequate lung expansion; secretion retention due to ineffective cough; and immobility that promotes hypoxemia, atelectasis, and pneumonia. The use of analgesics is the most common method to relieve pain induced by CTR, but this maneuver is often performed without the use of analgesics drugs or other analgesic techniques. Furthermore,the use of specific analgesics outside of environments considered protected, such as intensive care, is still some what a taboo. A recent literature review emphasizes how current pain management protocols associated with CTR, using a variety of pharmacological and non-pharmacological techniques, are either non-existent or unsatisfactory. Yet the control of pain is a specific competence and requirementofour profession—even legally—for all ages. Through the use of validated tools, our study compares a new analgesic protocol (Group A: drugs Atropine mg/kg, Midazolam mg/kg, andKetamine mg/kg) versus Paracetamol mg/Kg (Group B), the drug mostly used as an pediatric analgesic. Methods: A multi-center comparative study. Results: During the period between January 9, 2018 and March 31, 2018, we observed 32 participants in two centers. The average age of participants was five and a half years. T-tests for dependent and independent samples were performed. In the standardized samples, pre- and post-CRT pain evalutations were performed. The pre-procedure evaluation between the two samples shows no statistically significant difference (p=0.154). At post-evaluation, the protocol GroupA showed a significant difference (p=0.001) compared to the protocol Group B. Conclusion: Preliminary results show a greater efficacy with protocol Group A compared to Paracetamol for the management of pain also outside of the pediatric intensive care unit, when CTR is actuated in a ward of pediatric cardiac surger